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General Enquiry Form

If you enquiring about becoming an ambassador, volunteering or supervision, please use the form below and tick the relevant boxes below.

Name *

First

Last

Email *

Email

Confirm Email

Mobile phone number *

I'm enquiring about: (tick all that apply) *

• Quarterly newsletter
• Quarterly prayer newsletter
• Making a regular donation
• Becoming an associate counsellor
• Supervision enquiry
• Making a referral on behalf of someone else
• 6 monthly fundraising newsletter
• A student placement
• Volunteering in other ways
• Becoming an ambassador
• Other (Please specify below)

Further information on your enquiry - for counselling please use the counselling registration page.

I'm happy to receive mailing information from the Light House by: *

• Email
• Post
• Text
• None of the above

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• 02476 440095
• office@lighthousechristiancare.co.uk
• 1A Argyll Street, Coventry, CV2 4FJ